chairman dodd, senator isakson, alexander coburn and roberts i'm happy are co-sponsors of the legislation i believe it's entirely appropriate to consider this appropriate as part of this title since we're trying to increase the supply of physicians in this country, especially primary care physicians. and if this bill were to go through, mr. chairman, i think we could pass 2220 and we still wouldn't have enough docs in the system to take care of the population. the 2220 pathway is only available until june 30, 2009 bausz of the changes in 2007. if there was ever a time to act without interruption it's now. i would ask unanimous consent of the chair that i enter into the record a letter received -- or dated 23 june from the ama, which shows the ama's support for this piece of legislation, as well as a letter that was sent to secretary margaret spellings when she was then secretary of education. and it is signed by 97 medical associations and state medical societies including every state medical society in the nation calling for the reinstatement of 2220. with recent reports showing the unit

alexander? >> aye. >> senator burr? senator isakson? senator mccain? >> aye by proxy. >> senator coburn? >> no. >> senator roberts? > aye by proxy. >> chairman kennedy? >> aye by proxy. i want to recommend that all future amendments be offered by senator sanders. very good, senator. lamar alexander, you're up. >> thanks, mr. chairman. i have an amendment to title three, section 311. the purpose of it is to make sure that the right choices program which is in that title doesn't require the states to spend any money on it, and this is a relatively small item, probably, but i would like to make a larger point in making my proposal, if i could say just a word about it. >> certainly. >> we have talked a lot here about cost and usually the cost is described in terms of cost to the federal government, and the cbo, congressional budget office, score has said that the kennedy bill even without three of its major points would add $1 trillion over ten years. senator gregg has said that once the program is implemented fully by the fifth year, it would be more like $2.3 trillion. but i would like to talk about a different sort

alexander? >> no by proxy. >> senator byrd? >> no by proxy. >> senator mccain? >> aye by proxy. >> senator coburn? senator roberts? >> no. >> aye by proxy. >> did senator coburn vote? has he voted? >> no . >> senator bingham votes no by proxy. >> senator sanders, did you get that? >> yes. >> did you get that? all right. >> vote is ten ayes. >> it is not agreed to. all i can say is my nose counting was correct. >> it sure was. where are we here at this point now? are there any additional amendments? >> mr. chairman? >> senator casey. >> i just wanted to get back to the fraud and abuse section for a couple of moments. i know senator enzi had some comments before. we were dealing with senator mccain's amendment so i wanted to just respond to a couple of things. first of all, i wanted to commend the way senator enzi, along with our chairman has conducted himself in this whole process over these many days and weeks, and grateful for the way he approached this bill, as difficult as it is. and as much as there is conflict on a lot of major elements. with regard to the fraud and abuse section, i wanted to do a couple of t

alexander? >> aye by proxy. >> senator isaacson? >> senator mccain? >> aye by proxy. >> senator coburn in. >> aye by proxy. >> senator roberts? chairman kennedy? >> no by proxy. >> the vote is 10 ayes, 13 neys. >> the amendment is defeated. and you were very persuasive. i'm shoe there will be more work done on this before we're through. senator alex and her an amendment. i know senator sanders has an amendment and senator harkin has amendment number two which goes to the investment of funds. since we're on that subject matter as his -- here's what i'm going to do. it's noon. the idea would be -- we'll go into the half hour. we won't have any -- i won't ask for -- unless we can wrap the things up in 20 minutes. senator coburn has three amendments. others as well. i point out again that thanks to the work of senator harkin and senator enzi's staff and others involved in this. there were 50 amendment that's were agreed to out of 170. they did hard work. so even though we didn't debate all the amendments, that's a tremendous effort. i appreciate the things. i would -- tom, you are ready to go, tom harkin? are you ready to offer y

alexander. >> [ inaudible ]. >> senator mccain. >> [ inaudible ]. >> senator hatch. >> no by proxy. >> senator mutuali in in ing -- >> no by proxy. >> test eign ayes, 13 nays. >> number 72. >> coburn amendment number 72. >> mr. chairman? since we decided we didn't like my idea of sending it all back to states, what this is is a compromise that says, perhaps we would allow hersa to contract in the states for states to put all -- funnel all their stuff into their three most areas of acute short aage. all we're saying with this is, whatever the title is that we've got, whatever we do, this allows hersa to form a contract with the state to funnel all these monies into their three or more acute shortages. we still get money into the state but we add some flexibility into the state based on differing state needs. i think this will give flexibility to accomplish what senator murray is trying to accomplish. it still has control. it allows hersa to be in charge of that control. but it's an imperfect solution as compared to what i offered earlier and was defeated. but i think this one makes some sense, that allows the flexibility to really address the varying needs of the various states. th

alexander? >> aye by proxy. >> senator byrd? >> aye by proxy. >> senator isaacson? >> aye by approximatey? >> senator mccain? >> aye by proxy. >> senator hatch? >> aye by proxy. >> senator coburn? >> aye. >> senator roberts. >> aye. >> senator kennedy? >> no by proxy. >> ten ayes. it appears to be nay. the amendment is not agreed to. here's where we are and senator coburn is leaving. i was hoping to get done by tomorrow midday, but we're going to finish, so i -- i don't want to keep people in the evenings if we can't consider amendments, but i don't know -- we have the fraud and abuse section now to go to and about -- >> there are eight people here, mr. chairman? we have eight, i know, and i think we ought to keep working at the thing. >> do it. >> i don't have amendments. do we have amendments? >> mr. chairman, i just want to thank all of the senators as we finish our first title, many across the aisle working with us to get this done and i appreciate all the work. >> we thank you immensely and thank you staff as well and, first of all, for taking the number of amendments and getting agreements on as many. i think roughly half of the amendments we found agreement on, and that